Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | COA.12665-NP | OH |
NPI | 1215204292 |
---|---|
Provider Name | Mrs. Dianne Louise Bunner |
First Address | Geneva, OH 44041 |
Second Address | Cleveland, OH 44106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2011 |
Last Update Date | 19/11/2011 |